碘己醇是估计肾小球滤过率的可能方法吗?

Q4 Medicine
Fabrizio Cristiano, Guillermo Rosa-Diez, Carlos Guido Musso, Jenny Cristiano
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引用次数: 0

摘要

肾小球滤过率(GFR)的测量在慢性肾病(CKD)和常染色体显性多囊肾病(ADPKD)的诊断和治疗中是必不可少的,两者都需要精确的肾功能评估。传统上,GFR是用内源性标志物如肌酐和胱抑素C来估计的,但由于与肾功能无关的因素,如肌肉质量和饮食,这些指标可能不准确。碘己醇清除方法提供了一种比菊粉或放射性标记等传统标记更准确、侵入性更小的替代方法。碘己醇是一种非离子型水溶性造影剂,完全通过肾小球滤过消除,因此非常适合直接估计GFR。本文描述了碘己醇清除的程序,包括静脉给药后确定间隔的血液样本。在肾功能正常的患者中,采样间隔更频繁,而在晚期CKD患者中,包括ADPKD患者,较慢的碘己醇消除需要更宽的间隔,以确保准确的清除率分析。即使与其他标记物相比,碘己醇也具有很高的精度和可重复性。研究支持使用碘己醇有效监测CKD和ADPKD进展。特别是在ADPKD中,iohexol可以检测细微但具有临床意义的GFR变化,即使在疾病的早期阶段,这使得它对评估靶向治疗有价值。然而,由于高成本和严格的协议,碘己醇的使用仅限于专门的中心。它在先进的欧洲医疗机构的实施强调了它的功效,提供可靠的GFR估计,加强肾脏学实践,尽管有一些限制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Is Iohexol a Possible Method for Estimating Glomerular Filtration Rate?

The measurement of glomerular filtration rate (GFR) is essential in diagnosing and managing chronic kidney disease (CKD) and autosomal dominant polycystic kidney disease (ADPKD), both requiring precise renal function assessment. Traditionally, GFR has been estimated using endogenous markers like creatinine and cystatin C, though these can be inaccurate due to factors unrelated to kidney function, such as muscle mass and diet. The iohexol clearance method provides a more accurate and less invasive alternative to traditional markers like inulin or radioactive markers. Iohexol, a non-ionic, water-soluble contrast agent, is exclusively eliminated by glomerular filtration, making it highly suitable for direct GFR estimation. This paper describes procedures for iohexol clearance, involving defined-interval blood samples after intravenous administration. In patients with normal renal function, sampling intervals are more frequent, while in advanced CKD patients, including those with ADPKD, slower iohexol elimination requires wider intervals to ensure accurate clearance analysis. Iohexol has demonstrated high precision and reproducibility, even compared to other markers. Research supports using iohexol to monitor CKD and ADPKD progression effectively. Particularly in ADPKD, iohexol detects subtle but clinically significant GFR changes, even in early disease stages, making it valuable for evaluating targeted therapies. However, iohexol use is limited to specialized centers due to high costs and strict protocols. Its implementation in advanced European healthcare facilities underscores its efficacy, providing reliable GFR estimates that enhance nephrology practice, despite some limitations.

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来源期刊
CiteScore
0.70
自引率
0.00%
发文量
62
期刊介绍: Il Giornale Italiano di Nefrologia (GIN) è la rivista di educazione continua della Società Italiana di Nefrologia SIN ed è pubblicato bimestralmente. E" il più autorevole organo di informazione nefrologia disponibile a livello nazionale. Il giornale Italiano di Nefrologia offre la più aggiornata informazione medico-scientifica rivolta al nefrologo sotto forma di rassegne, casi clinici e articoli finalizzati all’Educazione Continua in Medicina, oltre ai notiziari ed agli atti dei congressi di questa prestigiosa Società Scientifica
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